Introduction
Filler injections, though generally safe, can lead to complications ranging from minor and temporary to serious and long-lasting. Understanding facial anatomy and filler properties is key to preventing and managing these complications effectively. ALWAYS CHECK CAPILLARY REFILL (TEST AFTER INJECTING) AND APPLY PRESSURE FOR 5 SECONDS. IF IT TAKES 3 SECONDS OR MORE FOR COLOUR TO RETURN REPORT TO YOUR DOCTOR (OVER 65 CAN BE UP TO 4.5 SECONDS).
Hydration and room temperature can affect the return rate. The absence of pain does not guarantee occlusion has not occurred. Occlusion can occur over 24 hours due to secondary pressure effects (or more).
Tyndall Effect
Hyaluronic acids (HAs) might refract blue light, appearing blue under the skin, if injected too superficially. Treatment involves puncturing the area with a 20-gauge needle to express the product. This technique is particularly useful for the lower face but challenging for lower lids, where hyaluronidase injections are preferred.
Herpetic Outbreak
Herpetic outbreaks can occur post-lip injection in patients with previous herpes infections. Prophylactic treatment with Valtrex (500 mg) starting three days before the procedure is recommended. In case of eruptions, more aggressive therapy may be necessary.
Nodules and Lumpiness
Post-injection, patients may experience clumps of product. Techniques like massaging during injection and applying warm compresses can help. Persistent lumps may require treatment with hyaluronidase.
Granulomas
Granulomas, which are reactions to the product, may appear months post-injection. Treatments include Kenalog injections, oral methylprednisolone, oral antibiotics, and possibly excision. Some practitioners also use 5-fluorouracil (5-FU).
Delayed Hypersensitivity
Characterized by erythema around the injection site weeks or months later, this condition may be related to biofilms. Treatment options include oral fluoroquinolones or macrolides for up to six weeks. Steroids and NSAIDs, which can promote biofilm formation, should be avoided.
Vascular Compromise
Vascular compromise can occur due to various reasons, including intravascular injection. Immediate actions include stopping the injection, massaging the area, applying warm compresses, and potentially using hyaluronidase. Monitoring and documenting the patient’s condition is crucial.
Blindness
Blindness, though rare, is a serious complication, especially with nasal injections. Knowledge of nasal vascular anatomy is essential. Immediate actions include emergency manoeuvres and consulting an ophthalmologist. Systemic steroids, antibiotics, and low-molecular-weight heparin may be considered in management. Protocols change from time to time and the latest protocol should always be referred to.
Hyaluronidase must be checked before commencing injecting for sufficient quantities and expiry dates.
This guide aims to equip cosmetic nurses and Doctors with the basic knowledge and skills necessary to manage filler injection complications effectively, ensuring patient safety and optimal outcomes.
Urgent contact with an experienced supervising (and at all times available) Doctor is essential for assistance in treating complications.
